Southern Folk Medicine

by Phyllis D. Light

  In addition to other Old World cultural elements, Spanish physicians and soldiers brought the conventional medicine of Europe to the New World. Its basis was in Greek or humoral medicine (hereafter known as humoral medicine), and embodied various theories and practices that evolved over centuries in the Mediterranean region. Later, known as Galenic medicine, Greek medicine spread across Europe, continuing to evolve along the way and taking on regional and cultural variations. Galenic medicine was used by European and Spanish physicians and influenced Western conventional medicine until the nineteenth century.

  Like many folk medicines, humoral medicine was not initially a uniform system, but was drawn from the region’s diverse areas, climates, and spiritual belief systems. Most likely the Greek humoral system was influenced somewhat by ancient Egypt, whose physicians were considered the finest in the area.

  The Egyptians also documented their herbal and medical practices. The Kahoun Papyrus dates from 1825 BCE and includes sections on herbs, surgery, and diagnostics. The Ebers Papyrus, a 110-page herbal text that dates to 1550 BCE, was copied from earlier texts and offers a wealth of information. The ancient Egyptians believed that the heart was the organ most responsible for good health and the center of fluid movement around the body. Already you can see the beginnings of the humoral system in the ancient writings.

  The Ebers Papyrus accurately describes such conditions as angina pectoris, aneurysm, and hernia. It discusses how to examine all the body fluids, including blood, mucus, urine, perspiration, tears, and feces. Also noted were the use of nutrition for health, the limbs, color of skin and face, quality of light in the eyes, and the smell of sweat, breath, and the body fluids. Most important to the examination was the taking of the pulse and the temperature of various parts of the body. This was, to say the least, a complete and thorough physical examination based on observational signs and the symptoms reported by the patient, a lost art in our modern approach to medicine where physical assessment skills are often left to machines and technology.

  Ancient Egyptians believed that some illness was the result of angering the Gods. However, the physicians also used a theory based on the channels that farmers dug for irrigation. The heart was the center of forty-six channels that ran through the body. If any of the channels became blocked, illness could occur. Herbs, movement, and spiritual practices were designed to unblock the channels or appease the gods and allow the fluids to move freely. For example, mental illness was believed to be the result of blocked channels and angering the gods.

  Many of the herbal remedies used by ancient Egyptians are still in use today for the same health issues or disorders. For example, garlic was used for asthma, pneumonia, and other bronchopulmonary complaints. We now know that when the sulfur compounds in garlic are metabolized, there is a concentrate of the compounds in the lungs, sweat, and urine. That’s why garlic lovers have garlic breath and can stop a vampire at twenty-five paces. Garlic was used for sore throat and earache, both modern herbal uses also. Castor oil was used as a laxative, cedar oil as an antiseptic, and willow for pain reduction. All of these are still in use. This supports the concept in folk medicine that if a remedy works, it continues in use. If a remedy doesn’t work, it drops out of the repertoire.

  In ancient Greece, humoral medicine had its roots in the Cult of Asclepius, who was considered the God of Medicine. Asclepius was the son of the god Apollo and the mortal Coronas, but was raised by the centaur Chiron, who taught Asclepius the healing arts. It is said that Chiron was the first teacher of medicine and knew all the uses of the plants. In addition to skill in herbal crafts, Chiron also taught healers to use prayer, incantations, ointments, and surgery for healing.

  Asclepius carried a staff with a serpent intertwined around it (the symbol of modern medicine) and became so good at healing that he could revive the dead. Raising the dead was a crime against the natural order and brought Asclepius to the attention of Mount Olympus. Zeus, fearing that the land would become overpopulated, killed Asclepius with a thunderbolt and carried him to Mount Olympus to become a god. Asclepius, God of Medicine, married Epione, Goddess of Soothing Pain, and had four daughters, all of whom worked in the healing arts. Hygeia was the Goddess of Good Health; Panacea, the Goddess of Curatives and Medicines; Aceso, the Goddess of Healing and Curing; and Iaso, the Goddess of Remedies and Modes of Healing. A young man, Telesphoros, the God of Convalescence, is often seen with Asclepius, but the relationship between the two is unclear.

  The Cult of Asclepius began about the sixth century BCE with temples built around Greece and later Rome. The temples were a cross between a spa, a hospital, and a religious site where the sick could go for healing. While the Cult of Asclepius created priests, it also gave birth to a family of physicians who claimed direct descendance from Asclepius and are considered the true source of Greek medicine.

  However, it was Hippocrates (460–370 BCE) and his students who first defined and wrote about humoral medicine in a functional and scientific manner. They were also the first physicians to recognize that illness had a natural cause, in contrast to the more superstitions views of the time, which related the cause of illness to supernatural influences.

  Hippocrates’s contributions to medicine stand to this day. In addition to being the first to place and order healing knowledge into a scientific system, Hippocrates and his students were the first to separate magic from medicine and to make medicine a profession. Hippocrates was a teacher and the founder of a school of medicine that flourished for several hundred years and influenced conventional medicine for over 2,000 years. Hippocrates’s Corpus is a collection of work that spans the fifth and fourth centuries BCE and discusses a wide range of topics such as diseases of women, epidemics, and surgery. Much of Hippocrates’s writings are still available today.

  Galen (129–c. 200 AD) further refined and expanded the basic concepts of Hippocrates’s humoral system. His views on medicine were developed using both empiricism and observation, believing that experience was the best teacher, but that theoretical knowledge also held a place in the study and application of medicine.

  He began his early studies in the temples of Asclepius but later moved to Rome and became a physician at the Roman court. Galen believed that disease was caused by an imbalance in the humors, but unlike Hippocrates who believed the humors were imbalanced over the entire body, Galen believed the humors could become imbalanced within an organ or localized area as well. He believed in experimentation to increase knowledge, in dissection, and in the Vital Spirit. He discovered veins, arteries, and the movement of blood around the body and felt the pulse as a form of diagnosis. Galen categorized herbs according to their energetic properties: heating, cooling, moistening, or drying. Much of his work is still applicable today.

  Galen’s influence on the humoral model crafted early folk medicine into university-worthy teaching material. This is one of the reasons the Greek humoral system became known as Galenic medicine.

  Galenic medicine lost prominence as physicians began to view the body as a mechanical entity rather than spiritual one. But this was a slow process and occurred over time. Galen’s medicine continued to influence the view of the body even after the discovery of the germ theory. In addition to his own works and writings, Galen also offered commentaries on Hippocrates’s writing. About a third of Galen’s writings survive today; that’s about three million words. His writings influenced both Western and Islamic medicines.

  Other influential physicians and writers of the humoral system include Avicenna, an Arab philosopher, physician, and brilliant medical scholar who contributed the idea that disease could be contagious. Like Hippocrates, Avicenna thought that disease could be distributed by water or land. He believed that psychology influenced health and believed in the mind/body connection. This prodigy wrote the Canon of Medicine at a young age, which is still in print today.

  While there were many other influential physicians, herbalists, and healers of Galenic medicine, the works of these thre
e formed the foundation of humoral healing knowledge. Other authors I also suggest include Dioscorides (40–90), Hildegard of Bingen (1098–1179), Maimonides (1135–1204), Paracelsus (1493–1541), and Nicholas Culpeper (1616–1654). Humoral medicine is currently experiencing a resurgence in British folk medicine, as revived by Christopher Hedley, evolved and tweaked for modern times.

  I want to know about the visible fluids and don’t hesitate to ask my clients about their bowel movements, their color and mucous content, and general gassiness. I’ll also ask about the length of their bleeding times, in cuts and injuries, as well as menstrual bleeding, or the color of their urine. Understanding the movement of the major body fluids and what constitutes healthy fluids can be important in assessing health patterns.

  The influence of humoral medicine on the folk medicine of the South cannot be overstated.

  As we discuss the concepts of Southern Folk Medicine, it seems evident that the humoral system of Europe, in its form at the time of settlement of the New World, met and intertwined with the Indigenous folk medicines and uses of medicinal plants of the New World (which could also technically be called humoral systems). This melding occurred not only in the Southeastern United States, but also in Mexico, the Caribbean, and South America—other areas which the Spanish explored and conquered.

  A Quick Overview of the Humoral System

  The humoral system’s primary concept is that both health and disease are influenced by the complex interactions among a person’s four humors. These interactions are affected by their lifestyle, diet, habits, emotional stability, and environment. Therapeutic approaches based on an individualized assessment can help bring balance to the humoral makeup.

  Any humoral system, whether Greek, Native American, Southern Folk Medicine, Traditional Chinese Medicine, or Ayurveda, which developed in a time when people lived close to the Earth and used a language based on local climate, topography, and land, will have some similarities. Folks depended upon the land for their food, clothing, and shelter. The lives of the people were totally entwined with every aspect of living on the land, and for this reason, they used a land-based vocabulary. The vocabulary forms the basis of most all folk medicines regardless of cultural origin.

  The four humors are blood, phlegm, bile, and black bile. While three of the four relate quite easily to body fluids, the fourth, black bile, has been defined alternately as toxins, necrosis, or excrement—basically, all the nasty stuff. All humors were believed to be made by the liver from digestion of food—which isn’t a far stretch when you think about the role the liver plays in the digestive process, methylation, and metabolism of all substances we take into our bodies.

  The four humors form in the body and move through it. With the humors in balance, a person is healthy; an imbalance of any of the humors causes illness. To return to health, a balance of humors must be reinstated. This is a continual process since the humors are in perpetual motion. Humors are affected by a person’s mental and physical health, and also their disposition.

  In the humoral model, an excess or deficiency of one or more humors results in imbalance and illness. The excess or deficiency is assessed within a person’s individual constitution. Almost anything could shift a humor to excess or deficiency: too much wine, not enough food, too little exercise, too much exercise, not enough sleep, working in a toxic environment, a fight with your lover, or the death of a loved one. According to Hippocrates, the humors could be brought back into balance by targeted nutrition and lifestyle changes. Galen added the use of medicinal herbs as a therapeutic approach and categorized the herbs into a useful system for ease of use.

  The four humors or fluids corresponded to the four elements of Greek philosophy—fire, water, air, and earth—these four elements composed all matter, each with a specific characteristic. Earth is solid and heavy and flows downward, collecting in the feet, legs, bowels, and abdomen. Water is liquid and heavy and flows downward, collecting in the same areas as earth. Wind or air is gassy and light, and flows upward and outward, though it may move around the lower body without pattern. Fire flows upward and out, but burns in the digestive tract and reproductive organs.

  Within the humoral system—based on the Greeks’ Mediterranean environment—yellow bile is considered hot and dry, like fire upon the land. Phlegm is considered cold and wet, like swampy water. Blood is considered hot and wet, like the air coming in from the Mediterranean Sea. And black bile is considered cold and dry, like the dirt beneath the surface of the land or within a Mediterranean cave. Because health and the humors are connected to the land, certain seasons of the year then influence the movement of the humors around the body.

  Hot, cold, and warm are humoral values used to describe an analogical quality that can be applied to food, herbs, remedies, physical conditions, and temperaments, as well as thermal temperatures. This is also true of the humoral qualities of wet, dry, moist, hard, soft, rising, falling, high, low, thick, and thin, and other qualities used also in Southern Folk Medicine.

  The qualities—hot, cold, wet, dry—result from opposing characteristics of the humors. This paring of opposite qualities is very influential in Southern Folk Medicine: hot/cold; wet/dry. For example, phlegm is cold and moist while blood is hot and moist. The qualities of the humor then influence the temperaments: sanguine (blood), choleric (bile), phlegmatic (phlegm), or melancholic (black bile). Temperaments not only describe physical complaints or symptoms but also personality and emotional outlook. They are assessed by several physical and psychological markers, including physical characteristics of the face and skin, as well as personality traits.

  The temperaments are ever-changing and interact with each other. For example, if a substance becomes too hot, it can also become dry. These four basic temperaments can combine in various ways to create sixteen different combinations of temperaments that can be measured by observation and assessment.

  The humors influence the temperaments. Blood is hot and moist; phlegm is cold and moist; bile is hot and dry; and black bile is cold and dry. When the humors are in balance, Vital Energy is strong and the body is healthy. In humoral medicine, each body fluid is associated with an emotion: blood (sanguine, happy, creative); phlegm (satisfied, dull, lazy); bile (choleric, ambitious, energetic); and black bile (melancholic, introverted, self-pitying).

  The equivalent of a temperament in Southern Folk Medicine is the constitution. Understanding the personality and physical makeup of a constitution is an important assessment tool for herbalists and healers in Southern Folk Medicine. Rather than the imbalance being considered the cause, it’s the observation of the fluids that is important for seeing markers or signs of an imbalance that needs addressing.

  For a deeper understanding of humoral medicine in modern days, I refer you to The Traditional Healer’s Handbook (1991) by Hakim G.M. Chishti. Matthew Wood, a well-known herbalist from Minnesota, has written extensively on the humoral system in several of his books and a number of articles. Christopher Hedley, an herbalist in London, has done much to revitalize humoral medicine in modern-day herbalism in Britain.

  The four humors, and the humoral language, were such a normal part of Elizabethan English life that their influence can be seen in Shakespeare’s plays and sonnets. He uses the language of the four humors to describe the personalities of his characters, their physical form, and their psychological motivations. What may be even more remarkable is that Shakespeare’s audience understood his words perfectly through the lens of the four humors—the humoral language was that common! I would also like to note that Elizabeth I was queen of England at the time of the first discoveries of the New World, and her successor, James I, authorized the translation of the King James Bible that so influenced Southern Folk Medicine and Christianity in the New World. That version of the Bible is also filled with humoral language.

  Once we earnestly begin our introduction into Southern Folk Medicine, the influence of the basic principles of the humoral system will be quite obvious. Yet the
re will be pronounced differences as well.

  I leave this discussion with a quote from Shakespeare’s Hamlet (melancholy, black bile): “I have of late, but wherefore I know not, lost all my mirth, forgone all custom of exercises; and indeed, it goes so heavily with my disposition that this goodly frame, the earth, seems to me a most sterile promontory; this most excellent canopy, the air, look you, this brave o’er hanging firmament, this majestical roof fretted golden fire: why it appeareth nothing to me but a foul and pestilent congregation of vapors.… Man delights me not; nor woman neither.”

  Native American Influence

  While the humoral medicine of the Old World is a major influence on Southern Folk Medicine, it is just one. Without the ability to utilize the native plants of the New World, settlers would have been missing the most important tool of the healing arts—the herbs themselves. Although some food and medicinal plants from Europe arrived with the colonists, they soon had to turn to local plants to survive. Local plants were also economically important as new medicines and ornamentals that could be a source of trade in the home country.

  Plants that made the journey from Europe and became naturalized—dandelion, cleavers, chickweed, calendula, elecampane, red clover, alfalfa, and mullein to name a few—soon spread from the gardens of the settlers into the local environment, and are now common in herbalists’ materia medica. Red clover can now be found growing wild in all of North America. It’s everywhere! These naturalized plants have become so common that many modern herbalists don’t fully understand their unique properties and use them more as beverage teas.

  The know-how to use local, native plants was gleaned from Indigenous peoples by settlers, indentured servants, and slaves. Here in the South, the Creeks (Muskogee) and the Cherokees (Tsalagi) were the primary tribes that interacted with the white invaders. Native Americans were often reluctant to share health practices with the white man simply because many health practices were also considered spiritual practices. Native remedies that were shared with the white man were the more commonly used herbal ones that many people in the tribe might know. Spiritual practices, on the other hand, were sacred knowledge that only a few might possess. A vast number of the native Eastern woodland plants used in modern herbalism are based on this greater shared knowledge. We owe a huge debt to Native Americans for our current ability to use native plants effectively.